Isolated limb perfusion (ILP) and isolated limb infusion (ILI) are alternative approaches for regional chemotherapy treatment.
During ILP the limb vasculature is isolated from that of the rest of the body and a high dose of a chemotherapeutic agent (e.g. melphalan) can be delivered to the tumor-bearing tissues. Regional drug concentrations can be administered up to a 10-fold of what is tolerated systemically. Due to the isolation of the limb, systemic toxicity is absent or negligible. Isolation is achieved by ligation or temporary occlusion of collateral blood vessels and the placement of a proximal tourniquet. The limb blood flow is then pumped through an oxygenator and a heat exchanger in an external circuit to provide oxygenated and temperature regulated regional perfusion.
The ILP technique involves a technically complex and invasive operative procedure, requiring open surgical cannulation of the vessels at the root of the extremity. In addition, ILP requires expensive equipment, occupies a surgical operating room for a long period and involves a substantial number of surgical, anesthetic and perfusion staff and nursing personnel. It is only available in specialized centers and is considered less appropriate in elderly patients or those with serious medical co-morbidities. Complications from ILP are not uncommon Significant regional toxicity such as skin necrosis, compartment syndrome and peripheral neuropathy can occur. Vascular catastrophe requiring arterial reconstruction or amputation is uncommon but has been reported.
Isolated limb infusion (LIL) is a low flow, minimally invasive alternative to open complex surgical procedure isolated limb perfusion. Certain differences are evident: ILI is low flow, minimally invasive percuataneous catheters, tourniquet isolation of the extremities and is acidotic and not oxygenated. ILP is high flow, involves an open complex surgical procedure involving open cannulation of the vessels, it is oxygenated, and aerobic. ILI is very repeatable, whereas ILP is difficult to repeat in the same extremity.